BROADWAY THEATRE OF PITMAN
CHILDREN’S SUMMER CAMP APPLICATION
JULY 20 - AUGUST 7, 2015
and
AUGUST 10 – AUGUST 28, 2015
Please complete a separate application for each child attending camp
Child’s Name ___________________________________________Age as of June 1, 2015 ________________________
Street Address ____________________________________________________________________________________
City/State/Zip _____________________________________________________________________________________
Mother/Guardian’s Name ___________________________________________________________________________
Father/Guardian’s Name ____________________________________________________________________________
Home Phone _______________________________________ Alternate Phone # ______________________________
Mother’s E-mail Address ______________________________ Mother’s Cell/Work Phone # ______________________
Father’s E-mail address _______________________________ Father’s Cell/Work Phone #_______________________
Please list TWO emergency contact people and their phone numbers, who are NOT the parents of the child:
1._________________________________________________ Phone # ______________________________________
2._________________________________________________ Phone # ______________________________________
Summer Camp 1: July 20 – August 7, 2015
Children aged 5-9 will be performing "Disney’s Sleeping Beauty KIDS.” Children aged 10-13 will be performing "Mulan Jr”.
Young adults aged 14-18 will be performing “Shrek.” The morning session runs 9:00 AM – 12:00 PM and the afternoon session
runs 1:00 PM – 4:00 PM. Each age group will have one morning session and one afternoon session. Full-day session runs
9:00 AM - 4:00 PM, and a lunch consisting of a sandwich, bottled water, and fruit is included in the fee. Full-day campers will
have different roles in each of their two performances. Please indicate which session you would like your child to attend:
MORNING
AFTERNOON
NO PREFERENCE
FULL DAY
The performances will be on Saturday, August 8th and Sunday, August 9th. Due to the nature of our camp, students must be
willing to commit to attend all sessions as well as the performance. There is a mandatory orientation meeting on Tuesday,
July 14, 2015 at 7PM at the Broadway Theatre of Pitman that campers and their parents/guardians are expected to attend.
Summer Camp 2: August 10 – August 28, 2015
Children aged 5-9 will be performing "Disney’s 101 Dalmatians KIDS.” Children aged 10-13 will be performing "Seussical Jr”.
Young adults aged 14-18 will be performing “Hairspray.” The morning session runs 9:00 AM – 12:00 PM and the afternoon
session runs 1:00 PM – 4:00 PM. Each age group will have one morning session and one afternoon session. Full-day session
runs 9:00 AM - 4:00 PM, and a lunch consisting of a sandwich, bottled water, and fruit is included in the fee. Full-day campers
will have different roles in each of their two performances. Please indicate which session you would like your child to attend:
MORNING
AFTERNOON
NO PREFERENCE
FULL DAY
The performances will be on Saturday, August 29th and Sunday, August 30th. Due to the nature of our camp, students must be
willing to commit to attend all sessions as well as the performance. There is a mandatory orientation meeting on Tuesday,
August 4, 2015 at 7PM at the Broadway Theatre of Pitman that campers and their parents/guardians are expected to
attend.
Page 1 of 4
Based on feedback from our previous campers, we have added an early drop-off and a late pick-up service for all camp
sessions. You may now elect early drop-off or late pick-up adding 1 hour prior to the beginning of camp or at the end of camp.
You may choose either the early drop-off or late pick-up option or you may select both services at the same time. The
additional fee for either early drop-off or late pick-up is $75. If you choose both options the fee is an additional $150.
Please list four other people (other than yourself) who are authorized to pick up your child. If a person comes to pick up your
child and they are not on the list, your child will not be released. You must submit a signed letter if you would like to add
anyone to this list in the future.
1.________________________________________________ 2._____________________________________________
3.________________________________________________ 4._____________________________________________
 I give permission for my child to walk home from the program unattended.
In consideration of my child participating in this summer camp program, I ____________________________________, on
behalf of myself, my heirs, personal representatives, and all those claiming by or through me consent to, and so hereby
discharge and release and forever hold harmless Preserve Pitman Investment Group, LLC dba Broadway Theatre of Pitman and
their affiliates, sponsors, agents, servants, employees, assigns, successors, and heirs and any facility at which events are held,
from any and all claims, actions, losses, damages, or expenses for personal or bodily injury (including death), and property lost
or damage of whatever nature or cause, incurred by me (or my child) arises out of or any conjunction with my (or my child’s)
participation in the aforementioned event. I hereby consent that I am of legal age and have read and understand the contents
of this consent and release.
Signature of Parent or Guardian Named Above _____________________________________________________________
Emergency Hospital Permission:
I hereby give my permission to any staff member at Broadway Theatre of Pitman Summer Camp to drive my child to the
emergency room of the local hospital in the event of a medical emergency. At the discretion of the Broadway Theatre of
Pitman, emergency services may be utilized in lieu of transportation by Theatre personnel.
List all allergies or special medical information.
1.________________________________________________ 2._____________________________________________
3.________________________________________________ 4._____________________________________________
Pediatrician’s Name ____________________________________ Phone _____________________________________
NOTE: Please do not bring your child to camp if he/she is ill. Children who have a fever or are taking medication for an illness
should not attend camp. NO MEDICATION can be administered by the staff. Children are not allowed to self-administer or
carry any prescription or non-prescription medicine with them. Any such medicine will be confiscated and returned to the
parent/guardian at the end of the day. Bringing any medication to camp may result in permanent dismissal from camp.
Pictures will be taken during the camp. I give Broadway Theatre of Pitman permission to include my child in these pictures
and for them to be used by the Broadway Theatre of Pitman at their discretion.
 Yes  No
Shirt Size: (Circle One)
YS
YM
YL
AS
AM
AL
AXL
Summer Camp Program Goals:
1. To foster a positive self-image in our children and a belief in their own abilities to succeed by recognizing their talents,
accomplishments, and worth as individuals.
2. To contribute to our children’s education by providing opportunities for hands-on and active learning.
3. To enable children to develop their own minds and unique perspectives through programming that encourages
imagination, creativity and expression.
4. To offer a safe, quality, and affordable camp to parents and caregivers.
5. Have fun.
Page 2 of 4
Registration:
Camp registration begins Wednesday, October 1, 2014. Please be advised that registration is on a first-come, first-served basis.
Early registration is strongly encouraged since space is limited and camp fills up quickly. Children with incomplete or missing
components of the application form or missing payment will not be permitted to attend camp until all information and
payments are complete. A confirmation letter will be mailed to the parent/guardian by the Broadway Theatre no later than
July 1, 2015. Payment for camp is completely non-refundable for any reason whatsoever.
Conduct While Attending Camp:
We work to maintain an atmosphere of mutual caring, respect, and understanding at the Summer Camp. Proper participation
and conduct by your child is expected and includes the following rules:
1.
2.
3.
4.
5.
6.
7.
8.
Respect other’s feelings and property.
Cooperate with each other.
Listen to your teachers/counselors.
Stay with your group.
No fighting, yelling or cursing.
Tell a teacher/counselor if someone/something is bothering or upsetting you.
Clean up after yourself.
Have fun.
Please discuss and reinforce these behavioral expectations with your child.
Staff supervises all Summer Camp activities and helps children resolve conflicts and problems as they arise. Behavioral
redirection is seen as an opportunity for learning and approached accordingly. However, if a child continually disrupts the
program, or poses a safety risk to himself/herself or others, then a written behavioral notice will be sent home to the
parent/guardian explaining the issue to be addressed. In the event that two written behavioral notices are sent home during
the course of the camp, the Broadway Theatre of Pitman reserves the right to dismiss the child from the camp without refund
or reimbursement.
Drop-Off/Dismissal/Pick-Up Policy:
A parent/guardian will be expected to sign their child in for each session. Children may not arrive unattended. If a child
arrives unattended, they will not be allowed to participate and the child’s parent/guardian will be contacted to pick up their
child. This policy is necessary in order for the Broadway Theatre of Pitman to know which children are in attendance.
Each day at the conclusion of the session, children will be dismissed to their parent/guardian. Your child will only be dismissed
to the people you have listed on the Summer Camp application. If you would like your child to walk home from camp by
themselves, you must grant that permission on the Summer Camp application. A parent/guardian will be expected to sign out
their child each day.
The camp closes at 12:00 PM and 4:00 PM respectively. Any child picked up 10 minutes after dismissal will be charged a $15
late fee for every 15 minutes the child is not picked up. Two latenesses may result in dismissal from the camp. If the
parent/guardian fails to pick up their child within 15 minutes of dismissal, the Broadway Theatre of Pitman will ensure that:
1. the child is supervised at all times;
2. staff will attempt to contact parent/guardian/emergency contacts to discuss pick up options; and
3. at 60 minutes passed dismissal, the staff will contact the NJ Division of Youth and Family Services to seek assistance in
caring for the child until an authorized person is able to pick up the child.
If the parent/guardian appears to be physically and/or emotionally impaired to the extent that, in the judgment of the Camp
Director and/or staff member, the child will be placed at risk of harm if released to such an individual, the Broadway Theatre of
Pitman will ensure that:
1. the child will not be released to such an impaired individual;
2. staff members will attempt to contact an alternate parent/guardian for pick up; and
Page 3 of 4
3. if the Broadway Theatre of Pitman is unable to make alternate arrangements, the staff will contact the NJ Division of
Youth and Family Services to seek assistance in caring for the child until an authorized person is able to pick up the
child.
Clothing:
Children must wear comfortable clothing to camp (t-shirts, shorts, sneakers with socks, etc.). Sandals are not permitted.
Campers will receive one free camp t-shirt on the final day of camp. Additional t-shirts may be purchased for $10 each.
Parents/Guardians should use discretion when dressing their children for camp. Inappropriate clothing may result in a written
behavioral notice being issued to the child.
Payment/Authorization:
Circle the appropriate fees!
Camp fee:
$300 Half Day / $750 Full Day
Early Drop-Off:
$75 (8 AM drop-off for morning session and 12 PM drop-off for afternoon session)
Late Pick-Up:
$75 (1 PM pick-up for morning session and 5 PM pick-up for afternoon session)
Drop-Off/Pick-Up:
$150 (8 AM drop-off and 1 PM pick-up for morning session)
(12 PM drop-off and 5 PM pick-up for afternoon session)
Select Your Summer Camp:

Summer Camp 1 (“Disney’s Sleeping Beauty KIDS” / Mulan Jr / Shrek)

Summer Camp 2 (Disney’s 101 Dalmatians KIDS / Seussical Jr / Hairspray)
Total Camp Fee: $_____________________
Payment Due Date:
______________________________________________________
Signature of Parent/Guardian
Date
With Application
Please charge the camp fee to:
 Visa
 MasterCard
 American Express
Credit Card Number _________________________________ Exp. Date: ______ 3/4 digit Security Code: _________
Check Enclosed: 
Check # ___________
Return this completed application along with payment to the Broadway Theatre of Pitman, PO Box 118, Pitman, NJ 08071. If
you have any questions, please contact Customer Service at 856.384.8381 Monday through Friday, 8 AM to 4 PM. The physical
address of the theatre (but not the mailing address) is 43 South Broadway, Pitman, NJ 08071. All pages of this application
must be submitted in its entirety. Applications are processed on a first-come, first-served basis. Submit your application
early to ensure availability for your child(ren). Payment for camp is completely non-refundable for any reason whatsoever.
Federal Tax ID Number: 20-4308225
Page 4 of 4